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Erschienen in: Archives of Gynecology and Obstetrics 1/2017

15.05.2017 | Review

Cytomegalovirus infection in pregnancy

verfasst von: Karl Oliver Kagan, Klaus Hamprecht

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 1/2017

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Abstract

Purpose

Due to the severe risk of long-term sequelae, prenatal cytomegalovirus infection is of particular importance amongst intrauterine viral infections. This review summarizes the current knowledge about CMV infection in pregnancy.

Methods

A search of the Medline and Embase database was done for articles about CMV infection in pregnany. We performed a detailed review of the literature in view of diagnosis, epidemiology and management of CMV infection in pregnancy.

Results

The maternal course of the infection is predominantly asymptomatic; the infection often remains unrecognized until the actual fetal manifestation. Typical ultrasound signs that should arouse suspicion of intrauterine CMV infection can be distinguished into CNS signs such as ventriculomegaly or microcephaly and extracerebral infection signs such as hepatosplenomegaly or hyperechogenic bowel. Current treatment strategies focus on hygienic measures to prevent a maternal CMV infection during pregnancy, on maternal application of hyperimmunoglobulines to avoid materno-fetal transmission in case of a maternal seroconversion, and on an antiviral therapy in case the materno-fetal transmission have occurred.

Conclusion

CMV infection in pregnancy may result in a severe developmental disorder of the newborn. This should be taken into account in the treatment of affected and non-affected pregnant women.
Literatur
3.
Zurück zum Zitat Picone O, Vauloup-Fellous C, Cordier AG et al (2013) A series of 238 cytomegalovirus primary infections during pregnancy: description and outcome. Prenat Diagn 33:751–758. doi:10.1002/pd.4118 CrossRefPubMed Picone O, Vauloup-Fellous C, Cordier AG et al (2013) A series of 238 cytomegalovirus primary infections during pregnancy: description and outcome. Prenat Diagn 33:751–758. doi:10.​1002/​pd.​4118 CrossRefPubMed
5.
Zurück zum Zitat Hamprecht K (2017) Update CMV, personal communication Hamprecht K (2017) Update CMV, personal communication
7.
Zurück zum Zitat Britt W (2015) Controversies in the natural history of congenital human cytomegalovirus infection: the paradox of infection and disease in offspring of women with immunity prior to pregnancy. Med Microbiol Immunol 204:263–271. doi:10.1007/s00430-015-0399-9 CrossRefPubMed Britt W (2015) Controversies in the natural history of congenital human cytomegalovirus infection: the paradox of infection and disease in offspring of women with immunity prior to pregnancy. Med Microbiol Immunol 204:263–271. doi:10.​1007/​s00430-015-0399-9 CrossRefPubMed
14.
Zurück zum Zitat AWMF (2014) Labordiagnostik schwangerschaftsrelevanter Virusinfektionen S2 k-Leitlinie AWMF Registernummer 0093/001. 1–209 AWMF (2014) Labordiagnostik schwangerschaftsrelevanter Virusinfektionen S2 k-Leitlinie AWMF Registernummer 0093/001. 1–209
16.
Zurück zum Zitat Yamamoto AY, Mussi-Pinhata MM, Boppana SB et al (2010) Human cytomegalovirus reinfection is associated with intrauterine transmission in a highly cytomegalovirus-immune maternal population. Am J Obstet Gynecol 202(297):e1–e8. doi:10.1016/j.ajog.2009.11.018 Yamamoto AY, Mussi-Pinhata MM, Boppana SB et al (2010) Human cytomegalovirus reinfection is associated with intrauterine transmission in a highly cytomegalovirus-immune maternal population. Am J Obstet Gynecol 202(297):e1–e8. doi:10.​1016/​j.​ajog.​2009.​11.​018
17.
18.
Zurück zum Zitat Voigt S, Schaffrath Rosario A, Mankertz A (2016) Cytomegalovirus seroprevalence among children and adolescents in Germany: data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), 2003–2006. Open Forum Infect Dis. doi:10.1093/ofid/ofv193 PubMed Voigt S, Schaffrath Rosario A, Mankertz A (2016) Cytomegalovirus seroprevalence among children and adolescents in Germany: data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), 2003–2006. Open Forum Infect Dis. doi:10.​1093/​ofid/​ofv193 PubMed
20.
Zurück zum Zitat Lipitz S, Yinon Y, Malinger G et al (2013) Risk of cytomegalovirus-associated sequelae in relation to time of infection and findings on prenatal imaging. Ultrasound Obstet Gynecol 41:508–514. doi:10.1002/uog.12377 CrossRefPubMed Lipitz S, Yinon Y, Malinger G et al (2013) Risk of cytomegalovirus-associated sequelae in relation to time of infection and findings on prenatal imaging. Ultrasound Obstet Gynecol 41:508–514. doi:10.​1002/​uog.​12377 CrossRefPubMed
21.
Zurück zum Zitat Bilavsky E, Pardo J, Attias J et al (2016) Clinical implications for children born with congenital cytomegalovirus infection following a negative amniocentesis. Clin Infect Dis 63:33–38. doi:10.1093/cid/ciw237 CrossRefPubMed Bilavsky E, Pardo J, Attias J et al (2016) Clinical implications for children born with congenital cytomegalovirus infection following a negative amniocentesis. Clin Infect Dis 63:33–38. doi:10.​1093/​cid/​ciw237 CrossRefPubMed
22.
Zurück zum Zitat Hamprecht K, Bissinger AL, Arellano-Galindo J et al (2014) Intrafamilial transmission of human cytomegalovirus (HCMV): long-term dynamics of epitope-specific antibody response in context of avidity maturation. J Clin Virol 60:119–126. doi:10.1016/j.jcv.2014.03.006 CrossRefPubMed Hamprecht K, Bissinger AL, Arellano-Galindo J et al (2014) Intrafamilial transmission of human cytomegalovirus (HCMV): long-term dynamics of epitope-specific antibody response in context of avidity maturation. J Clin Virol 60:119–126. doi:10.​1016/​j.​jcv.​2014.​03.​006 CrossRefPubMed
23.
Zurück zum Zitat Schoppel K, Kropff B, Schmidt C et al (1997) The humoral immune response against human cytomegalovirus is characterized by a delayed synthesis of glycoprotein-specific antibodies. J Infect Dis 175:533–544CrossRefPubMed Schoppel K, Kropff B, Schmidt C et al (1997) The humoral immune response against human cytomegalovirus is characterized by a delayed synthesis of glycoprotein-specific antibodies. J Infect Dis 175:533–544CrossRefPubMed
25.
Zurück zum Zitat Karacan M, Batukan M, Çebi Z et al (2014) Screening cytomegalovirus, rubella and toxoplasma infections in pregnant women with unknown pre-pregnancy serological status—PubMed—NCBI. Arch Gynecol Obstet 290:1115–1120. doi:10.1007/s00404-014-3340-3 CrossRefPubMed Karacan M, Batukan M, Çebi Z et al (2014) Screening cytomegalovirus, rubella and toxoplasma infections in pregnant women with unknown pre-pregnancy serological status—PubMed—NCBI. Arch Gynecol Obstet 290:1115–1120. doi:10.​1007/​s00404-014-3340-3 CrossRefPubMed
27.
Zurück zum Zitat Leruez-Ville M, Stirnemann J, Sellier Y et al (2016) Feasibility of predicting the outcome of fetal infection with cytomegalovirus at the time of prenatal diagnosis. Am J Obstet Gynecol 215(342):e1–e9. doi:10.1016/j.ajog.2016.03.052 Leruez-Ville M, Stirnemann J, Sellier Y et al (2016) Feasibility of predicting the outcome of fetal infection with cytomegalovirus at the time of prenatal diagnosis. Am J Obstet Gynecol 215(342):e1–e9. doi:10.​1016/​j.​ajog.​2016.​03.​052
31.
Zurück zum Zitat Hui L, Wood G (2014) Perinatal outcome after maternal primary cytomegalovirus infection in the first trimester: a practical update and counseling aid. Prenat Diagn 35:1–7. doi:10.1002/pd.4497 CrossRefPubMed Hui L, Wood G (2014) Perinatal outcome after maternal primary cytomegalovirus infection in the first trimester: a practical update and counseling aid. Prenat Diagn 35:1–7. doi:10.​1002/​pd.​4497 CrossRefPubMed
34.
Zurück zum Zitat Liesnard C, Donner C, Brancart F et al (2000) Prenatal diagnosis of congenital cytomegalovirus infection: prospective study of 237 pregnancies at risk. Obstet Gynecol 95:881–888PubMed Liesnard C, Donner C, Brancart F et al (2000) Prenatal diagnosis of congenital cytomegalovirus infection: prospective study of 237 pregnancies at risk. Obstet Gynecol 95:881–888PubMed
35.
Zurück zum Zitat Enders G, Bäder U, Lindemann L et al (2001) Prenatal diagnosis of congenital cytomegalovirus infection in 189 pregnancies with known outcome. Prenat Diagn 21:362–377. doi:10.1002/pd.59 CrossRefPubMed Enders G, Bäder U, Lindemann L et al (2001) Prenatal diagnosis of congenital cytomegalovirus infection in 189 pregnancies with known outcome. Prenat Diagn 21:362–377. doi:10.​1002/​pd.​59 CrossRefPubMed
36.
Zurück zum Zitat Donner C, Liesnard C, Brancart F, Rodesch F (1994) Accuracy of amniotic fluid testing before 21 weeks’ gestation in prenatal diagnosis of congenital cytomegalovirus infection. Prenat Diagn 14:1055–1059CrossRefPubMed Donner C, Liesnard C, Brancart F, Rodesch F (1994) Accuracy of amniotic fluid testing before 21 weeks’ gestation in prenatal diagnosis of congenital cytomegalovirus infection. Prenat Diagn 14:1055–1059CrossRefPubMed
37.
Zurück zum Zitat Enders M, Daiminger A, Exler S et al (2017) Prenatal diagnosis of congenital cytomegalovirus infection in 115 cases: a 5 years’ single center experience. Prenat Diagn 198:380. doi:10.1002/pd.5025 Enders M, Daiminger A, Exler S et al (2017) Prenatal diagnosis of congenital cytomegalovirus infection in 115 cases: a 5 years’ single center experience. Prenat Diagn 198:380. doi:10.​1002/​pd.​5025
41.
Zurück zum Zitat Hamilton ST, van Zuylen W, Shand A et al (2014) Prevention of congenital cytomegalovirus complications by maternal and neonatal treatments: a systematic review. Rev Med Virol 24:420–433. doi:10.1002/rmv.1814 CrossRefPubMed Hamilton ST, van Zuylen W, Shand A et al (2014) Prevention of congenital cytomegalovirus complications by maternal and neonatal treatments: a systematic review. Rev Med Virol 24:420–433. doi:10.​1002/​rmv.​1814 CrossRefPubMed
46.
Zurück zum Zitat Buxmann H, Stackelberg OMV, Schlößer RL et al (2012) Use of cytomegalovirus hyperimmunoglobulin for prevention of congenital cytomegalovirus disease: a retrospective analysis. J Perinat Med 40:1–8. doi:10.1515/jpm-2011-0257 CrossRef Buxmann H, Stackelberg OMV, Schlößer RL et al (2012) Use of cytomegalovirus hyperimmunoglobulin for prevention of congenital cytomegalovirus disease: a retrospective analysis. J Perinat Med 40:1–8. doi:10.​1515/​jpm-2011-0257 CrossRef
47.
Zurück zum Zitat Rawlinson WD, Boppana SB, Fowler KB et al (2017) Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis. doi:10.1016/S1473-3099(17)30143-3 PubMed Rawlinson WD, Boppana SB, Fowler KB et al (2017) Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis. doi:10.​1016/​S1473-3099(17)30143-3 PubMed
48.
Zurück zum Zitat Thürmann PA, Sonnenburg-Chatzopoulos C, Lissner R (1995) Pharmacokinetic characteristics and tolerability of a novel intravenous immunoglobulin preparation. Eur J Clin Pharmacol 49:237–242CrossRefPubMed Thürmann PA, Sonnenburg-Chatzopoulos C, Lissner R (1995) Pharmacokinetic characteristics and tolerability of a novel intravenous immunoglobulin preparation. Eur J Clin Pharmacol 49:237–242CrossRefPubMed
50.
Zurück zum Zitat Visentin S, Manara R, Milanese L et al (2012) Early primary cytomegalovirus infection in pregnancy: maternal hyperimmunoglobulin therapy improves outcomes among infants at 1 year of age. Clin Infect Dis 55:497–503. doi:10.1093/cid/cis423 CrossRefPubMed Visentin S, Manara R, Milanese L et al (2012) Early primary cytomegalovirus infection in pregnancy: maternal hyperimmunoglobulin therapy improves outcomes among infants at 1 year of age. Clin Infect Dis 55:497–503. doi:10.​1093/​cid/​cis423 CrossRefPubMed
51.
Zurück zum Zitat Malek A, Sager R, Kuhn P et al (1996) Evolution of maternofetal transport of immunoglobulins during human pregnancy. Am J Reprod Immunol 36:248–255CrossRefPubMed Malek A, Sager R, Kuhn P et al (1996) Evolution of maternofetal transport of immunoglobulins during human pregnancy. Am J Reprod Immunol 36:248–255CrossRefPubMed
52.
Zurück zum Zitat Leruez-Ville M, Ghout I, Bussières L et al (2016) In utero treatment of congenital cytomegalovirus infection with valacyclovir in a multicentre, open-label, phase II study. Am J Obstet Gynecol. doi:10.1016/j.ajog.2016.04.003 Leruez-Ville M, Ghout I, Bussières L et al (2016) In utero treatment of congenital cytomegalovirus infection with valacyclovir in a multicentre, open-label, phase II study. Am J Obstet Gynecol. doi:10.​1016/​j.​ajog.​2016.​04.​003
56.
Zurück zum Zitat Kimberlin DW, Lin C-Y, Sánchez PJ et al (2003) Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: a randomized, controlled trial. J Pediatr 143:16–25CrossRefPubMed Kimberlin DW, Lin C-Y, Sánchez PJ et al (2003) Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: a randomized, controlled trial. J Pediatr 143:16–25CrossRefPubMed
Metadaten
Titel
Cytomegalovirus infection in pregnancy
verfasst von
Karl Oliver Kagan
Klaus Hamprecht
Publikationsdatum
15.05.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Archives of Gynecology and Obstetrics / Ausgabe 1/2017
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-017-4380-2

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